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SAN J OAQ N I N Environmental Health Department <br /> OUNT'Y <br /> Body Art Inspection Report <br /> Facility Name: Date: <br /> OLD VINE TATTOO(PALMER, JOSH) July 27, 2021 <br /> Facility Address, Facility Phone: Program Record: <br /> 521 W KETTLEMAN LN, LODI, CA 95242 (209) 395-9553 PR0546258 <br /> Permit Holder: Permit Expiration Date: <br /> PALMER, JOSH June 30, 2022 <br /> Inspection Type: Program: <br /> INSPECTION/SERVICE (Chargeable) 4120-BODY ART FACILITY-SINGLE USE <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of the California Health and Safety Code(HSC). <br /> V=Violation COS=Corrected on site <br /> Cleaning and Sterilization <br /> 1 HSG 119315(b) Autoclave:approved and effective-passed integrator test V _COS <br /> 2 HSC 1193C9, Items washed,disinfected, packaged,labeled,and sterilized ❑V ❑COS <br /> 119315(a) <br /> 3 HSC 119315(b) Autoclave loaded correctly/packages allowed to dry ❑V ❑COS <br /> 4 HSC 119315(b) Integrators used/monthly spore test/log maintained ❑V ❑COS <br /> 5 HSC 119314(c) Decontamination/sanitation area separated and supplied appropriately ❑V ❑COS <br /> 6 HSC 119315(f) Invoices and log kept for disposable,pre-sterilized equipment ❑V ❑COS <br /> 7 HSC 119314(e) Sharps containers labeled, used,and disposed of appropriately ❑V ❑COS <br /> 8 HSC 119310 Jewelry,tattoo and piercing equipment-clean and sterilized ❑V ❑COS <br /> Practitioner Health and Hygiene <br /> 9 HSC 11930e No eating,drinking or smoking-clean clothes ❑V ❑COS <br /> 10 HSC 119303(a) Hands washed effectively and timely ❑V ❑COS <br /> 11 HSC 119314(b) Handwashing facilities properly supplied and accessible,warm water ❑V ❑COS <br /> 12 HSC 119303(c) Hepatitis B vaccination ❑V ❑COS <br /> 13 HSC 119307 Bloodborne Pathogen training ❑V ❑COS <br /> 14 HSC 119303(a) Appropriate personal protective equipment available and used ❑V ❑COS <br /> Customers/Clients <br /> 15 HSC 11930DO) Branding is completed with no other customers in procedure area V i i COS <br /> 16 HSC 119302 Customers eighteen(18)years of age or older ❑V ❑COS <br /> 17 HSC 119303(a) Skin adequately prepared for procedure ❑V ❑COS <br /> 18 HSC 119303 Client records approved and available-Consent form and questionnaire ❑V ❑COS <br /> 19 HSC 119303(b) Appropriate aftercare instructions given to client 71 V n COS <br /> Machine Safety and Sanitation <br /> 20 HSC 119311(i) Safe machine design V i COS <br /> 21 HSC 119311(h) Machines cleaned and disinfected between clients ❑V ❑COS <br /> 22 HSC 11931-(g) Parts replaced between clients-grommets,elastic bands,etc. V i,COS <br /> Preventing Cross Contamination <br /> 23 HSC 119309 Workstation/procedure area decontaminated V COS <br /> 24 HSC 119301(k) Appropriate chemical disinfectant used ❑V ❑COS <br /> 25 HSC 119309(b) Disinfectant used appropriately/sufficient contact time ❑V ❑COS <br /> FA0026192 PRO546258 SCO05 07/27/2021 <br /> EHD Rev.6/15/2021 Page 1 of 3 Body Art OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/EHD <br /> 9 <br />